The Wearable Defibrillator as a Bridge to Reimplantation in Patients with ICD or CRT-D Infections

Objectives: The approach to treat device infection in patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) is a challenging procedure. Optimal treatment is a complete extraction of the infected device. Therefore, we investigated the management and outcome of patients with ICD or CRT-D infections using the wearable defibrillator (WD) as a bridge to re-implantation after lead extraction procedures.

Methods: A retrospective study was conducted on consecutive patients who underwent ICD or CRT-D removal due to device-related infections and were prescribed a WD at our center between January 1, 2012 and July 30, 2015. Clinical characteristics, device information, WD and re-implantation data were analyzed.

Results: Twenty-one patients (mean age 62.9 ± 9.4, male 76.19%) were included in the study. Complete lead extraction was achieved in all patients. Mean duration of postoperative antibiotic treatment was 17.6 ± 7.7 days (range 7–28). Mean time of hospitalization was 15.8 ± 8.5 days (range 4–30). Mean duration of WD use was 73.6 ± 53.2 days (range 32–246). No patient experienced any shock delivery during WD treatment. Mean follow-up time was 14.6 ± 9.8 months (range 1–30), showing survival rate of 100% and freedom from reinfection in all patients.

Conclusion: The WD seems to be a valuable bridging option for patients with ICD or CRT-D infections, showing no recurrent device infection after mean follow-up time of 14.6 ± 9.8 months. However, complete extraction of the infected device is also highly desirable.